1. Answering Clinical Questions at the Point of Care Cecilia Chang cchang@uptodate.com

2. Outline About UpToDate Evidence Grading How to Search Q & A

3. About UpToDate You don’t need more information You need the right information

4. Synthesizes the medical literature, incorporates the latest evidence, and provides specific recommendations for patient care 將醫學的文獻組織合併成為最終的實證, 並提供 明確的臨床經驗治療建議在病患處置照護上

5. The editorial process Leading and Evidence Based Literature and Resources UpToDate Topic Review Read..... Analyze..... Summarize.......... Synthesize.......... Expert Comments.......... Expert Opinion.......... Recommendations.......... Grade the Evidence.......... Editorial Peer Review.....

6. Quick Facts about UpToDate Topic reviews Patient Information Drug Information Written by Physicians for Physicians

7. Quick Facts about UpToDate  Journals: 460+ peer reviewed journals  Databases:  MEDLINE, The Cochrane Database, Clinical Evidence and ACP Journal Club  Guidelines  Clinical trials  FDA, CDC, NIH  Proceedings  Clinical experiences and observations

8. Specialties  Adult and Pediatric Emergency Medicine  Adult Primary Care & Internal Medicine  Allergy and Immunology  Cardiovascular Medicine  Endocrinology & Diabetes  Family Medicine  Gastroenterology & Hepatology  Hospital Medicine {NEW}  Hematology  Infectious Diseases  Nephrology & Hypertension  Neurology  Obstetrics, Gynecology & Women’s Health  Oncology  Pediatrics  Pulmonary, Critical Care & Sleep Medicine  Rheumatology

9. In Development Dermatology Psychiatry Surgery

10. Evidence Grading

11. Evidence Grading – UTD GRADE RECOMMENDATION GRADES Grade 1 Strong Recommendation Benefits clearly outweigh the risks and burdens (or vice versa) for most, if not all, patients “We recommend…” Grade 2 Weaker Recommendation Benefits and risks closely balanced and/or uncertain “We suggest…” EVIDENCE GRADES Grade AHigh Quality Evidence Consistent evidence from randomized trials, or overwhelming evidence of some other form Grade BModerate Quality Evidence Evidence from randomized trials with important limitations, or very strong evidence of some other form Grade CLow Quality Evidence Evidence from observational studies, unsystematic clinical observations, or from randomized trials with serious flaws

12. How to Search

13. New Search –search  display result  output Others –Evidence grading RECOMMENDATIONS –Calculators –Drug interactions –ECG Test –Movies

14. How to use UpToDate based on a Clinical Scenario Question: You are seeing a 9 month old girl with a history of fever >39ºC (102.2°F) for two days. She has no underlying medical problems and no exposure to ill contacts. However, she only received immunizations at two and four months of age. On physical examination, she is well appearing and has no source of fever. Should you perform any laboratory tests? Key words: Febrile infant

15. 使得醫療專家可以在搜尋與判讀的過程中節省時間, 將主 要的心力集中在研讀更重要的治療主題資訊上 UpToDate - Key Development Purpose Save your Time !! Save your Cost !! Answer Clinical Question !!